Scientific Session 1

This session will present cutting-edge hand and upper extremity therapy research you do not want to miss!

Improving Patient-Reported Outcome Measure Selection for Pediatric Hand Function

Purpose: Patient-reported outcome measures (PROMs) are gaining favor in clinical practice and research for their feasibility and capacity to gauge functional limitations in daily life, but consensus is not available on an appropriate PROM for use following pediatric hand surgery or therapeutic interventions. Many studies rely on unvalidated surveys or measure hand function using PROMs designed for the whole upper extremity, such as the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Pediatric Outcomes Data Collection Instrument, or Patient-Reported Outcomes Measurement Information System (PROMIS). Hand-focused PROMs may improve assessment specificity and reduce response fatigue. Our systematic review aimed to appraise all child-reported or parent-proxy PROMs that focus on pediatric hand function. In turn, we aimed to inform selection or development of a PROM that could become the gold standard for this patient population.

Methods: PubMed, Embase, CINAHL, and Scopus were searched. Eligible studies evaluated psychometrics of hand-function-focused PROMs among pediatric patients. Following PRISMA guidelines, two reviewers independently screened studies, extracted data, and assessed risk of bias. We appraised psychometrics and evidence quality using the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) methodology. We compared PROM content using the Occupational Therapy Practice Framework, with analyses of hand function categories (including isolated digit movement, fine-motor dexterity, precision pinch, resisted pinch, grasp, resisted grasp, release, and graded force) and relevant pediatric occupational domains (activities of daily living [ADLs], instrumental ADLs, education, and play/leisure). We analyzed readability based on the well-established SMOG and Flesch-Kincaid indices.

Results: Reviewers screened 2513 studies; 33 reports on nine PROMs were included. Existing validation covers few pediatric hand conditions, mainly cerebral palsy and brachial plexus birth injury, and notably excludes hand trauma and nearly all congenital differences. The Upper-Extremity Cerebral Palsy Profile of Health and Function Computerized Adaptive Test (UE-CP-PRO) and ABILHAND-Kids are the strongest candidates for generating a gold-standard PROM. Both have good evidence of responsiveness to surgical outcomes. The UE-CP-PRO has the highest-quality validity evidence for the broadest age range. Its item bank covers all eight hand function categories in our analyses and all relevant occupational domains; it offers flexible, patient-centered customizability through computerized adaptive tests of 5, 10, or 15 items. ABILHAND-Kids is a 21-item PROM that covers nearly all hand functions and occupational domains. Both the UE-CP-PRO and ABILHAND-Kids showed an eighth-grade reading level, failing the American Medical Association’s standard for adults.

Conclusion: This review supports evidence-based outcome measure selection in pediatric hand clinical assessments and research. We provisionally recommend the UE-CP-PRO or ABILHAND-Kids to measure postoperative and therapeutic outcomes for pediatric hand function. We encourage clinicians and researchers to consider trialing these PROMs in broader patient populations to establish validity for conditions such as congenital hand differences or traumatic injuries. We also encourage revising these measures and/or developing a novel, more comprehensive PROM that incorporates adaptive content for condition-specific outcomes and prioritizes readability to support child-reporting.

Presenter: Meagan Pehnke, MS, OTR/L, CHT, CLT

Relative Motion Extension Splint For Treatment Of Flexor Tendon Adhesions: Proof of Concept

Purpose: The purpose of this study is to determine if incorporating RMES splints during active range of motion exercises will position flexor tendons in relative extension, increasing total flexor tendon excursion during flexion exercises. Enhanced tendon excursion and differential glide between the FDS and FDP tendons can facilitate adhesion lysis.

Methods: A frozen cadaveric upper extremity was dissected to expose the middle finger FDS and FDP tendons and pulleys. The arm was mounted vertically with a fiberglass cast on the wrist to maintain it in neutral position. Sutures were placed at the FDS and FDP tendons at the wrist to hold a 10N weight, to replicate active contraction of the FDS or FDP muscle bellies. The relative starting positions of the tendons were marked at different levels (IIA, IIB, IIC). Differential glide between the FDS and FDP tendons were measured at each level under six test conditions: isolated FDS motion with and without RMES, isolated FDP motion with and without RMES, and non-isolated FDP motion with and without RMES. Non-isolated FDP motion was performed to represent active composite fist motion. After each test condition, the distance between the marked starting points at each level was measured to determine the distance of differential glide between the tendons. Each condition was measured three times by three separate individuals to confirm consistency.

Results: The addition of RMES during isolated FDS motion increased glide differential at zones IIA and IIB (0-1mm to 3mm), while zone IIC remained unchanged (3mm). The addition of RMES to isolated FDP exercises increased differential glide only at zone IIC (4mm to 6mm), while zones IIA and IIB remained unchanged (3mm and 4mm, respectively). The addition of RMES to non-isolated FDP exercises increased differential glide across all zones: IIA (4mm to 7mm), IIB (8mm to 10mm), and IIC (11mm to 13mm).

Conclusion: Our study measured the differential glide between FDS and FDP tendons in zone II with and without RMES and showed increased differential glide when RMES was in place. However, this study also shows that differential glide is not uniform throughout zone II which may explain why some zones are more prone to adhesion formation than others and why some adhesions are more resistant to therapy. This study demonstrates that the use of RMES during active range of motion exercises increases tendon excursion and the differential glide between the FDS and FDP tendons.

Presenter: Nicole Badalyan

Embedding Self-Management in Occupational Therapy for Patients with Upper Extremity Arthritis: A Pilot Program Evaluating Effects on Function, Pain , Self Efficacy, Fatigue, and Health Behavior

Purpose: Arthritis is a chronic condition and a leading cause of work-related disability, affecting 46.4 million U.S. adults and projected to impact 67 million by 2030 (Brady et al., 2008). Treatment includes NSAIDs, immune-modulating agents, and sometimes surgery. Self-management strategies are widely recommended to help individuals manage symptoms and lifestyle changes (Brady, 2012; Iversen et al., 2010). The CDC highlights benefits such as improved function, reduced pain, and lower healthcare costs. A national study found that self-management programs improved health behaviors and reduced ER visits and hospitalizations among older adults (Ory et al., 2013).
Despite this, few studies explore how healthcare professionals support self-management. Occupational therapy (OT) has demonstrated effectiveness in this area. A large RCT showed lifestyle-based OT reduced health and cognitive decline (Clark et al., 2009), while systematic reviews support OT for pain management, education, joint protection, and adaptive equipment (Carandang et al., 2016; Valdes & Marik, 2010).
To address this gap, we developed the Occupational Therapy Arthritis Self-Management Program, embedding self-management into evidence-based outpatient OT. This study evaluated its effectiveness in improving occupational performance, pain, self-efficacy, fatigue, health behavior, and satisfaction

Methods: This retrospective study was approved by Thomas Jefferson University's IRB. Data were retrieved from OT records at two outpatient clinics from October 2015 to January 2016.
2.1 Patients
Inclusion criteria: age 18+, intact cognition, arthritis diagnosis, and joint pain. Referrals came from primary care providers, rheumatologists, and hand surgeons.
2.2 Intervention
The program was based on the Person-Environment-Occupation Model (Law et al., 1996) and Social Cognitive Theory (Bandura, 1998). Over 6–8 weeks, patients completed 9–12 one-hour sessions combining OT and self-management education. OT evaluations included musculoskeletal assessments, the Canadian Occupational Performance Measure (COPM), and assessments of pain, fatigue, and self-efficacy.
Each session included individualized treatment from either the Occupational Performance or Symptom Management Module, plus strategies from Stanford’s Chronic Disease Self-Management Education. Patients received written materials and practiced health-promoting behaviors. Therapists used action plans and collaborative decision-making to guide treatment.
2.3 Outcome Measures
Measures included the COPM (performance/satisfaction), Visual Analog Scale (pain), 8-item Arthritis Self-Efficacy Scale, Multidimensional Assessment of Fatigue, a health behavior journal, and a satisfaction survey.
2.4 Data Analysis
Pre- and post-program scores were analyzed and compared to minimally important changes. Satisfaction responses were averaged.

Results: 3.1 Participants
Seven patients completed the program.
3.2 Outcomes
All patients showed improvements in occupational performance and satisfaction (≥2-point COPM increases). Pain decreased for all; three reached zero pain. Confidence rose for all, including those with high baseline self-efficacy. Four patients with arthritis-related fatigue improved by ≥5 points. Five of seven engaged in weekly health behaviors post-program. All participants reported satisfaction. Open-ended feedback noted plans to continue using physical activity, action plans, problem solving, and breathing techniques.

Conclusion: Combining OT with chronic disease self-management improved pain, fatigue, self-efficacy, occupational performance, and satisfaction. All patients achieved clinically meaningful outcomes. These findings support prior research on self-management benefits for pain, behavior, and function (Warsi et al., 2004). OT is well-suited for chronic disease support through collaborative goal-setting and education (Bondoc, 2015; Coleman & Newton, 2005).
Patients identified goals, learned self-management skills, and developed action plans. Most reported intent to continue using these strategies, reinforcing the impact of integrated education.
Limitations include a small sample size and short-term follow-up. Future studies should explore long-term outcomes in larger cohorts.
4.2 Conclusion
Chronic condition management benefits from programs that support behavior change. Integrating self-management into OT improved function, pain, fatigue, and satisfaction. The program offers a structured, replicable model with promising results. Further research is recommended

Presenter: Sakina Bohra, OTD, CHT

Exploring Centralized Mechanisms of Pain in persons with Non-Operative Thumb Carpometacarpal Osteoarthritis: A Quantitative Cross-sectional Study

Purpose: First carpometacarpal (CMC1) osteoarthritis (OA) is the most common and disabling form of upper extremity (UE) OA. Osteoarthritis is hallmarked by peripheral pain (PRP) resulting from structural pathology, but can also be linked to centralized pain (CSP), characterized by nociplastic changes in the central nervous system or “central sensitization.” Centralized pain can exacerbate symptoms and impact treatment responsiveness in persons with hip and knee OA, although its role in CMC1 OA remains understudied. Current orthopedic treatments for CMC1 OA focus on PRP, neglecting CSP. Given existing gaps in research and clinical practice, we sought to characterize CSP and explore its associations with UE symptoms and disability in adults with CMC1 OA.

Methods: The aims of this cross-sectional study were to 1) characterize central sensitization pain, 2) evaluate relationships between central sensitization pain, disability and other health variables, and 3) explore risk factors for central sensitization pain in adults with thumb carpometacarpal osteoarthritis.

For aim 1, the Central Sensitization Inventory was administered to assess self-reported symptoms of central sensitization pain. Descriptive statistics were used to characterize CSP among participants via CSI scores, CSI thresholds of clinical significance, and the total number of CSS diagnoses recorded in the health records. The results were expressed as frequency (count/percentage), range, mean, and SD values.

For aims 2 and 3, self-reported disability was assessed via the Michigan Hand Questionnaire, pain severity was assessed via pain numerical rating, disease severity was assessed through Eaton Littler staging, and health records were reviewed to quantify the numbers and types of pre-existing central sensitization syndromes (e.g., anxiety, depression, panic disorder, fibromyalgia, etc.). Preliminary tests of data normality were carried out to assess the distribution of outcome variables in the sample and inform the subsequent selection of tests of bivariate associations. Bivariate and multivariate analyses were used to evaluate correlational and predictive relationships between these variables and central sensitization pain.

Results: Seventy-eight adults with radiographically-confirmed CMC1 OA were included in this study. The participants’ characteristics are summarized in Table 1.  For aim 1: 68% of participants exceeded clinically significant central sensitization pain thresholds (Table 2). For aim 2: Central Sensitization Inventory scores correlated with disability (r=-.482, p<.001), pain severity (r=.362, p<.001), and number of pre-existing central sensitization syndromes (r=.546, p<.001). Pain severity (B=-2.70, p<.001), Central Sensitization Inventory scores (B=-.396, p=.004), and a diagnosis of panic disorder (B=-7.79, p=.079) predicted disability, while pain severity (B=1.63, p=.003) and number of pre-existing central sensitization syndromes (B=3.90, p<.001) predicted Central Sensitization Inventory scores. For aim 3, pain severity (B=.287, p=.02), was a risk factor for clinically significant central sensitization pain. Disease staging was not a predictor in any case.

Conclusion: The results of this study suggest that CSP, as assessed by the CSI, is common at clinically significant levels in adults with CMC1 OA, and is associated with worse pain severity and physical function. Further, CSP, pain severity, and pre-existing CSS have a significant impact on the extent of disability experienced by these patients. Finally, high pain severity serves as risk factors for clinically significant CSP. Our results align with trends observed in other populations, highlight the need for further research, and support the consideration of central sensitization pain when assessing and designing treatments for patients with CMC1 OA.

Presenter: Corey McGee, PhD, MS, OTR/L, CHT

Social Media Use Amongst Occupational Therapists Serving Individuals with Upper Extremity Disorders

Purpose: Occupational therapists (OTs) often use social media to network, access resources, and disseminate information to others. This study explores patterns of social media usage related to practice including preferred platforms, reasons to use social media, and perceived benefits and barriers to using information found on social media.

Methods: Researchers developed a survey to further investigate patterns of social media usage among practicing occupational therapists. The survey was disseminated to the American Occupational Therapy Association and American Society of Hand Therapists membership. Recruitment notices were also posted on professional social media groups across Instagram, Facebook, and LinkedIn, the three platforms most frequently used by OTs as identified in preliminary research. Data was collected via REDcap, a secure database. Inclusion criteria included licensed OTs who speak English and are currently practicing. Exclusion criteria included occupational therapy assistants, students, or other disciplines. Descriptive statistics were used to describe patterns of social media use. Open ended comments were gathered to expound on descriptive data.

Results: 154 social media users who identified as primarily serving the upper extremity and/or ortho population were pulled from a larger data set of all practicing OTs. Age group distribution was similar between age groups with 61+ having the least percentage of respondents (12%). Most respondents had 1-10 years’ experience (37%) and worked in outpatient settings (96.8%). Respondents primarily reported using Instagram (79.9%) and Facebook (66.9%) to find OT specific content. Primary reasons to use social media stratified by age are described in Figure 1. The most respondents reported using social media weekly (46.1%), following 1-5 social media accounts (60.4%) and engaging with posts through activities such as liking or commenting monthly (32.5%).  Benefits and concerns regarding social media use stratified by age are described in Table 1. Ethical considerations were noted by 77.9 % of respondents when implementing social media content into clinical practice. Considerations included concerns about the content being supported by evidence (69.5%), safety (50.6%), acceptability for all stakeholders (28.6%), and billability (21.4%). A large majority (81.2%) determined the credibility of OT content shared on social media. This credibility was established primarily by referring to trusted professional sources (68.8%), peer reviewed journals (51.3%), textbooks (29.3%), and recommendations from colleagues (16.2%).

Conclusion: Although our respondents use social media for a variety of reasons, interacting with posts or other professionals online occurs infrequently. The oldest age group shared their knowledge the most, consistent with their career longevity. Most common benefit of using social media was access to resources and information, including treatment ideas. Younger therapists cite treatment ideas as a reason to use social media the most, with a steady decline in reason to use as therapist age. Misinformation and Misleading content had the highest percentage of concern reported by all age groups. This may reflect a larger societal concern for misinformation online and supports that therapists are identifying content online that may not be credible. Older therapists use social media more for networking than younger therapists and realize the benefits of social media for networking more than younger therapists. The majority of respondents in all age groups are not using social media related to patient usage such as patient engagement and patient education. 

Presenter: Laurie Rogers, DHSc, OT, CHT

Implementation Determinants of Upper Extremity Injury Prevention Programs in Music Education: Insights from the Musculoskeletal Health for Musicians (MHM) Project

Purpose: Musicians are at high risk for performance-related musculoskeletal disorders (PRMD) of the upper extremity, negatively affecting their health, careers, and institutions. Despite evidence-based prevention strategies, formal upper extremity injury prevention programs are rarely integrated into music education curricula due to systemic barriers. The purpose of this study was to identify key factors impacting the implementation of such programs in collegiate music institutions to inform the development of a tailored toolkit supporting program adoption and sustainability.

Methods: A qualitative study design was used. Semi-structured interviews were conducted with 20 targeted stakeholders (including students, faculty, administrators, and clinicians) across four collegiate institutions (2 public, 2 private). Purposeful sampling ensured representation across diverse music disciplines and roles. Interviews were transcribed and coded using NVivo 15 software, with thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). A preliminary codebook was developed collaboratively, and independent coding was performed by two researchers to enhance reliability. Data saturation was approached by the 20th interview. Findings informed the development of a customizable toolkit to support institutional adoption of upper extremity injury prevention programs for collegiate musicians.

Results: Preliminary findings identified major themes across five CFIR domains. The top barriers to implementation included limited awareness of PRMDs, time constraints, difficulty accessing professional expertise, low perceived value, and budget limitations. Key facilitators included strong stakeholder value placed on prevention, interest among faculty and students, access to specialized resources, institutional support, and the presence of teacher champions. Flexibility of program delivery, curriculum integration, and clear actionable steps were consistently emphasized across stakeholders.

Conclusion: Findings underscore the critical need for an adaptable, user-friendly toolkit to promote upper extremity musculoskeletal health and prevent overuse injuries among collegiate musicians. Using insights from stakeholder interviews and evidence-based resources, a customizable organizational toolkit was developed to guide institutions through the implementation process, addressing key barriers and leveraging identified facilitators. The toolkit has been piloted across diverse collegiate music programs; evaluation of implementation outcomes and refinement of strategies are ongoing. This initiative advances the role of injury prevention in hand therapy by targeting an underserved, high-risk population through early education and systemic change.

Presenter: Aviva Wolff,  EdD, OTR, CHT

Filling the Knowledge Cup: Making Every Drop Count for Hand Therapy Research

Purpose: Purpose of  study - Identifying  hand therapists’ research priorities and determining if and  how priorities may have changed over two decades.

Study rationale - Aligning available funding to identified research priorities allows for advancement of the profession, improves patient care, and makes the most of available research funds.

Methods: Study design - Convergent mixed methods design. The survey used the same survey as published in 2002 with minor adjustments.

Participant recruitment - The electronic survey was sent out via email using Tri-Alliance contact information to 7093 hand therapists located  in the United States and internationally.

Data collection and analysis – Respondents’ demographic information was captured using quantitative questions that were analyzed and summarized using descriptive statistics, including weighted means. Qualitative questions identified research priorities and interests which were coded and subsequently assessed using Grounded Theory analysis and Constant Comparative methods. For trustworthiness, consensus was reached by all four authors in each phase of the analysis.

Results: Summary of findings - In total, 397 surveys were returned and analyzed from 47 states in the United States and five  countries (5.6% return rate, 95% confidence level, 5% margin of error). The majority of respondents were experienced hand therapists engaged in clinical practice  (mean years in practice 23.14 years, SD 10.78). The most frequently reported concerns were related to care provision, with emphasis on specific patient diagnoses conditions and reimbursement issues..

Respondents recommended  AHTF  support  clinical research grants  and outcome studies, specifically identifying the ideal hand rehabilitation management strategies, exploring orthosis use, and application of biophysical agents, specifically ultrasound and iontophoresis. The highest prioritized diagnoses and conditions were hand rehabilitation for unspecified tendon pathology,  lateral elbow tendinopathy, pain in general, and complex regional pain syndrome. Both quantitative and qualitative analyses identified outcomes research as a top priority showing agreement between the two research design methods.

Research participation interests included data collection and co-authorship. Respondents listed  the top barriers to participation in research activities as  time constraints, lack of proficiency, and limited research education. In comparison to the 2002 survey, practice settings changed from primarily therapist owned  to hospital out-patient, practice roles changed from senior therapist to staff therapist. Unforeseen findings from the current survey included research priorities inconsistent with reported clinical practice, omission of alternative treatment models, a lack of focus on the impact of the global pandemic, and no reduction in documentation time despite the adoption of electronic medical records.

Conclusion: Recommendations based on findings – Patient outcome and intervention studies should remain high priorities for AHTF research funding. Future AHTF priorities should include institutional, financial, and resource support for research education, especially grant-writing and making funding requests. The mixed-methods approach showed its value, because the two ways of inquiry complemented each other, with both concluding that AHTF focuses on therapeutic outcomes.

Clinical implication of the research/meaning of the study to the audience – The majority  of AHTF grant funding priorities were aligned with the most frequently managed conditions and performed clinical activities, rather than those identified as research needs. Analysis of the survey data indicated a need for more skilled hand therapy researchers. The authors concluded that the scarcity of scientifically trained hand therapy researchers emphasizes the need for combining clinical  and scientific expertise for hand therapy research. Collaborative partnerships are needed between clinicians and researchers to make “every drop count.”

Presenter: April Cowan, OTR, OTD, CHT

Comparing Outcomes of Conservative Rehabilitation Protocols for Camptodactyly in Paediatric Patients: A Retrospective Cohort Study

Purpose: Camptodactyly is defined as a flexion contracture of the proximal interphalangeal joint (PIPJ) initially presenting during infancy and/or adolescence. Most commonly, the contracture occurs in the small finger (D5), but it may affect multiple digits with or without association with distal arthrogryposis (DA). The etiological factors associated with camptodactyly are multifactorial and may include skin deficiency, hypoplastic muscles (e.g., lumbricals), shortening of tendons (e.g., flexor digitorum superficialis) and ligaments, and bony findings. The prevalence of camptodactyly has not been well-studied and is estimated to affect approximately 1% of the population. Children with camptodactyly commonly seek contracture treatment from hand therapists and surgeons, largely due to dissatisfaction with cosmetic appearance and functional ability. While surgical interventions exist, the potential for negative outcomes (e.g., loss of active flexion) and therefore reserved mainly for severe contractures. Therefore, literature prioritizes conservative treatment of camptodactyly with a combination of stretching and orthosis intervention to improve range of motion (ROM). The purpose of this study is to conduct a retrospective cohort study comparing the outcomes of conservative management for PIPJ contracture of children with camptodactyly and DA. The secondary goal is to compare whether conservative management outcomes differ between Type I (onset during infancy) and Type II (onset in adolescence) camptodactyly.

Methods: This study is a retrospective cohort design. The Sickkids Plastic Surgery Clinic database was reviewed to identify children with a diagnosis of camptodactyly. The inclusion criteria of the study were: diagnosis of camptodactyly or DA, aged birth to 18 years, and assessed by a therapist or surgeon at SickKids between March 15, 2013 – March 14, 2024. Children with associated syndromes and/or did not receive care by a hand specialist were excluded. Data were collected through a chart review of two medical record systems (e.g., EPIC). The primary outcomes data collected were the degree of PIPJ extension passive ROM (PROM) of affected digits pre- and post- treatment. Other data collected were participant demographics (e.g., age), type of camptodactyly (e.g., Type I, II), and type of rehabilitation intervention. Descriptive statistics were used to describe the cohort and Chi-Square analysis was used to compare the characteristics between camptodactyly and DA participants. Within each classification, paired comparative analysis (Wilcoxon Signed-rank) was used to measure change in PIPJ pre- and post- therapy. Additionally, comparative outcome of the mean difference in PIPJ between Types I and Type II was conducted (Mann Whitney U).

Results: Of 280 children found in the clinical database, 95 were included in the study. Sixty-five (68%) had camptodactyly and 30 (32%) had DA with equal presentation of females (n=48, 51%) and males. The average length of follow-up for this cohort was 3.6 + 5.1 years (mean + SD). At baseline, average isolated PIPJ extension PROM was –35.4±22.5 (camptodactyly) and -20.7±26.4 (DA), however, the DA cohort had significantly greater prevalence of bilateral flexion contractures (p = 0.001), co-morbidities (p < 0.001), and composite wrist and digital extension deficits (p < 0.001). Orthotic interventions differed between the two categories, fewer hand-based orthoses being prescribed for DA in comparison to children with camptodactyly (p = 0.05). The mean difference in PIPJ extension PROM pre- and post- treatment was 5.4 ±14.7 (camptodactyly) and 1.7±24.2 (DA). The effect of conservative management on PIPJ varied based on clinical presentation: significant improvements were found pre- and post- intervention in children with camptodactyly affecting one or more digits (p = 0.01) and D5 only (p = 0.006). However, changes in PIPJ were not significant in children with DA (p = 0.789). Further, no significant difference was found between Types I and Type II in their initial PIPJ extension PROM (p = 0.21) and treatment outcomes (p = 0.38).

Conclusion: Based on the findings of this study, camptodactyly and DA may require different hand therapy treatment protocols. Conservative management is indicated in both categories; however, interweaving interdisciplinary collaboration to provide both conservative and surgical intervention is recommended for children with DA. In this cohort, the lack improvement in isolated PIPJ extension PROM experienced by the children with DA should be considered alongside the high prevalence of composite wrist and finger extension deficits. Skin deficiencies may have largely contributed to the lack of progress with hand therapy. Future research should consider the child and family’s perspective of the functional and aesthetic impacts of these contractures and treatment outcomes.

Presenter: Emily Ho, PhD, OT Reg. (Ont.)

Determining the Inter and Intra Rater Reliability of the Complete Minnesota Dexterity Test in the Seated Position

Purpose: The purpose of this methodological study is to understand the inter and intra rater reliability of the Complete Minnesota Dexterity Test in the seated position. There are two main research questions for this study. The first question inquires: What is the inter and intra rater reliability of the Complete Minnesota Dexterity Test in the seated position for the general population? The second question is as follows: what is the difference between the intra and inter-rater reliability in sitting vs. standing for the general population? The Complete Minnesota Dexterity Test was originally normed to be conducted in a standing position, however, when utilized in practice, this test may be conducted in the seated position. Establishing reliability in the position in which it is performed is essential when considering the use of a standardized assessment in therapeutic spaces.

Methods: This is a methodological study to understand the inter and intra rater reliability of the Complete Minnesota Dexterity Test (CMDT) in the seated position. A total of 75 individuals participated in this study. Verbal consent was required to participate in this study. Participants who met inclusion and exclusion criteria were recruited from The George Washington University’s campus, through convenience sampling. IRB approval was obtained from The George Washington University on November 8, 2024. Two raters were used to establish interrater and intrarater reliability of the CMDT. Participants were asked to complete all of the subtests of this assessment three times, one practice, and two timed tests, including the placing test, turning test, displacing test, one hand turning and placing test, and two hand turning and placing test. Both raters timed participants as they completed each subtest, while also alternating who was reading test instructions. During the study, the student researcher switched the order of the subtest with each new participant by having each participant start at a different subtest, then completing the remaining subtests in order. Recruitment for this study took place between January and March of 2025.

Results: This study determined inter and intrarater reliability in sitting using 75 participants, consisting mostly of right handed (84.00%) women (78.67%) with two raters timing and recording the data of every participant. Both inter and intrarater reliability were determined to be high for the CMDT, as determined by the ICC values. Interrrater reliability ICC values for this study, in the seated position, were determined to be between .999 to 1.00 (Table 1). Intrarater reliability ICC values were also high, and were determined to be between .948 to .965 (Table 2). On the Bland-Altman test, very few data points breached the 95% confidence interval indicating good agreement. The smallest detectable change scores ranged from 0.0 to .055 for interrater and from .348 to 2.484 for interrater. Interrater reliability in the seated position was determined to be slight.y higher than prior reliability ICC values, which previously were determined to be between .87 to .95 (Walter, J.R. et. al., 2025).

Conclusion: The Complete Minnesota Dexterity Test is used in various spaces, such as therapeutic settings, however, this test has only been normed for certain populations, such as young, male factory workers. This test is currently only normed to be conducted in a standing position, however, when utilized in practice, this test may be conducted in the seated position. Establishing reliability in the position in which it is performed is essential when considering the use of a standardized assessment in therapeutic spaces. This study established excellent inter and intrarater reliability values by significant findings within a 95% confidence interval. This is the second in a series of studies to measure the psychometric properties of the CMDT in both sitting and standing.

Presenter: Amy Eybers, OT

Exploring Rehabilitation Practices Following Nerve Transfer Surgery for Adult-Acquired Brachial Plexus Injury: An Online Survey of Therapists

Purpose: This survey study was aimed to collect current rehabilitation approaches used by Hand Therapists for adult patients after receiving nerve transfer surgery following acquired brachial plexus injury (BPI). 
Adult-acquired brachial plexus injury is usually caused by traumatic events, such as motor vehicle collisions and motorcycle accidents. It typically affects young adults in their peak age of productivity, resulting in potential severe upper extremity functional impairments, activity limitations and participation restrictions. In the US, the medical community increasingly prefers nerve transfer over nerve grafting for brachial plexus injuries. Although nerve transfer surgery is gradually gaining popularity, a dearth of high-level evidence exists to support rehabilitation programming following nerve transfer surgery. This study provides insight into current rehabilitation practices following nerve transfer surgery. These data will support future research related to rehabilitation programs tailored to this population.

Methods: This study adopted a cross-sectional online survey design. The survey instrument was developed by an expert hand therapist (T.H.), who conducted a pilot test with a small sample of licensed occupational and physical therapists to evaluate the clarity, relevance, and comprehensiveness of the survey items. The finalized survey was then disseminated to members of the American Society of Hand Therapists (ASHT) via an email distributed by the organization on behalf of T.H. This survey will also serve as the preliminary survey of a larger modified Delphi study.
Participants completed the survey administered through the Qualtrics platform. The survey utilized both close-ended and open-ended items to collect quantitative and qualitative data. After data collection, data was exported to Microsoft Excel for data cleaning, preliminary analysis and visualization. After removing missing values and irrelevant answers, each entry was matched to a unique ID generated by the participant as part of the survey.  
Thematic analysis was performed on NVivo (Version 14) to explore patterns and insights in qualitative data. Thematic analysis was initiated by reading all answers and recording emergent themes on memo and generating codes. An open coding process was used to capture concepts and explore patterns relevant to the research question. To ensure analytical rigor, codes were iteratively revisited as new patterns emerged, allowing for the development of nuanced themes and cohesion across the dataset. Analytical memos were used throughout the process to document reflections, interpretation of themes and potential biases. Codes were grouped into categories as appropriate. Counting codes and identification of dominant themes were supported by functions in NVivo.

Results: A total of 30 hand therapist completed the full-length survey. Most survey respondents were occupational therapists (96.7%) and certified hand therapists (93.3%). More than half of the respondents had more than 15 years of professional experience (56.7%) and more than 15 years of clinical experience in hand therapy (53.4%). However, 69% of surveyed participants reported treating on average less than 5 clients with adult-acquired brachial plexus injury per year and 20% of participants reported not having experience treating clients following a nerve transfer surgery. A more detailed breakdown of participant characteristics is shown in Table 1. 
Survey results revealed significant variability in rehabilitation practices following nerve transfer surgery for adult-acquired brachial plexus injury, indicating a lack of consensus in many areas. The most prominent variability was observed in responses related to care management, particularly treatment visit frequency and caseload duration (Figure 1 and 2). In contrast, greater agreement was observed regarding patient-reported outcome measures, objective measures and the inclusion of range of motion exercises in home exercise programs, referral to mental health professionals for emotional challenges and positioning interventions for difficulty sleeping (Figure 3, 4, 5, 6 and 7). Throughout the survey, “it depends” was a very common response, reflecting the varied and complex nature of this patient population, client-centeredness of occupational and physical therapy professions, dynamic nature of working in an interdisciplinary team and in a larger healthcare ecosystem.

Conclusion: This exploratory survey study highlights the need for standardized, evidence-based rehabilitation guidelines that are comprehensive, client-centered, and adaptable. Future research should build on these findings to strengthen expert consensus, produce higher-level evidence, and support the development of accessible clinical protocols.

Presenters: Joy Xiao | Theresa Hallenen, DHSc, MS, OTR/L, CHT

Clinical Documentation Practices and Perspectives of Hand Therapists: A Cross-Sectional Survey Study

Purpose: Large-scale research using real-world hand therapy (HT) clinical data can provide insights into field-wide variability in practice patterns, helping to inform efforts to improve care effectiveness to meet diverse patient needs. Such research requires the synthesis of accurate clinical data from a wide range of HT settings; however, currently there is little knowledge on the field-wide state of clinical documentation. Therefore, the purpose of our study was to explore therapists’ perspectives related to documentation features, processes, content to: (1) establish foundational knowledge on nationwide documentation practices and (2) identify important considerations for development of future large-scale practice-based research efforts in HT.

Methods: We conducted a cross-sectional web-based survey study, distributed through the American Society of Hand Therapists and to authors of recent Journal of Hand Therapy and Hand Therapy publications. An initial invitation email and 2-week reminder were sent, and the survey was open from 06/26/2024 to 7/7/2024. Participants were eligible if they were U.S.-based occupational or physical therapists who had treated HT patients within the past year. Multiple choice, multiple selection, and numeric entry questions elicited information on (1) professional and practice setting characteristics, (2) clinical documentation features (3) clinical documentation processes, (4) the importance level and reporting of multidimensional patient factors.

Clinician responses were examined via descriptive analyses to identify trends and variations across the content areas, as well as via comparative analyses (Mann-Whitney U, Pearson’s Chi-squared, and Fisher’s exact tests, with Benjamini-Hochberg adjustments) to  identify potential differences in (1) documentation processes based on practice setting and (2) the extent to which patient factors were captured based on clinicians’ perceptions of their importance to hand therapy care.

Results: Of the 201 recipients who opened the survey, 190 (95%) completed the participant screening page and 165 (82%) completed all survey sections. Clinicians who completed the survey hail from 40 different states and are predominantly occupational therapists (94%) and certified hand therapists (86%) with a median of 20 years of HT experience. These clinicians mainly practice in freestanding or hospital-based outpatient clinics (49% each) located mostly in suburban environments (62%), followed by urban (30%), and rural (8%) environments.

Among responding clinicians, 98% use electronic medical record (EMR) systems (29 identified), with 75% linked to larger healthcare entities or networks. The median minutes typically needed to complete various documentation types range from 10-25, with initial evaluations having the most variability (10-120 minutes).  Most clinicians (84%) reported they typically finish documentation by the end of the day, though only 31% during or immediately following therapy sessions (Fig. 1a). Clinicians frequently record clinical measures: 42% complete formal reassessments at least every few weeks and 68% often or routinely complete weekly solitary measures (Fig. 1b). Yet, 69% also reported only rarely or occasionally having enough time to document to their preferred standard. We found no significant differences in processes (time spent on documentation, frequency of measurement, completion timeframes, adequate time for documentation) between clinicians practicing in hospital-based vs. freestanding outpatient clinics.

Multidimensional patient factors (n=14) clustered into 3 tiers based on clinicians rating them as ‘more important’ vs. ‘less important’ to care (Fig. 1c), with Tier 1 factors (n=6) rated as more important by 88-95% of clinicians, Tier 2 (n=2) by 71-78%, and Tier 3 (n=6) by 46-58%. Most factors are consistently captured in at least one type of clinical documentation (Tier 1 factors by 100% of clinicians, 7 of the remaining 8 by >90%). Initial evaluations captured factors most comprehensively (median capture rate across factors: 95%), followed by formal reassessments (59%), discharge summaries (44%), treatment notes (29%), and intake forms (24%; Fig. 1d). For 3 of 8 factors expected to change over time, clinicians rating them as more important on average capture them in more types of documentation (p< 0.001, p=0.001, p=0.004).

Conclusion: Our findings provide a preliminary overview of HT documentation practices for future efforts toward large-scale practice-based research. Generally, hand therapists report measuring frequently, comprehensively capturing patient factors, and completing documentation in a somewhat timely manner. However, there is some concern about the accuracy and inter-clinician consistency of content due to the variety of EMR systems, the lack of adequate time for documentation, and the impact of beliefs on the documentation of outcomes.

Presenter: Katherine Loomis, MA, OTR/L, CHT